Introduction: The WHO has been recommended to the member countries to develope a national health system based on PHC. Also the WONCA has given emphased on improvement of rural health. There have been limited research studies done in Mongolia on rural health needs and improvement of PHC’ organizations for rural areas. Goal: To study on thinks of rural medical personnel and rural citizens about activity of PHC’ organization and it’s change in the nearest future. Objective: 1) To introduce with current situation of Soum and Inter-Soum hospitals; 2) To study on thinks of rural medical personnel about activity of Soum, Inter-Soum and Aimag hospitals and it’s further changing; 3) To study on satisfaction of rural citizens from activity of primary care organizations. Material and Method: This study was covered 205 rural medical personnel (physicians - 41, feldshers - 43, nurses - 65, laboratory technicians - 11, other personnel - 45) and 210 rural citizens (local government’ personnel – 86, workers of private entities – 41, herdesmen – 40, pensioners – 11, others – 32) from Arkhangai, Gobi-Altai, Dundgobi, Sukhbaatar, and Tuv aimags. Used a questionaire method (Questionaire for rural medical personnel was include 14 questions; for rural citizens – 13 questions). For analysis of collected materials were used biostatistic methods. Results: Among the rural medical personnel – respondents 77,6% were assess positively about current soum hospital activity, which shown that a soum hospital can been implemented own main functions – to delivery PHC to rural people. Also 67,3% of respondents have thinking positively about Bag’ feldsher unit and 74,6% of them have given a more attention to improve working condition for Bag’ feldshers. Most of respondents – rural citizens (62,9%-80,5%) has been satisfied with soum, inter-soum hospitals care and bag’ feldsher unit service. They have suggestions how to improve rural health facilities. Finally, most of respondents (as rural health personnel, as Conclusions: 1. Based on the results of our study (67,3-77,6% of respondents – rural medical personnel and 62,9-80,5% of rural citizens have a satisfaction with Soum and Inter-soum hospital services, and ctr.) we can conclude that rural health facilities in common have been functioned normally. 2. Most of rural health personnel (68,8% of respondents) has been supported to changing current Soum hospital and its improving as Soum health centre (by thinking 62,4% of respondents) in the nearest future. 3. Also most of rural citizens (77,7-83,3% of respondents) has thinking about changing and improving rural health facilities, especially about Soum health centre. It is very important for providing a health reform in Mongolian rural areas, successfull.

Recently, we had participated in the International Workshop on IT solutions for Health Research Governance and Management, which held in Ha Noi, Viet Nam. The WHO Regional Office for the Western Pacific has led and supported the development and implementation of integrated IT-based health research management systems in Cambodia, Fiji, the Lao People’s Democratic Republic, Mongolia, the Philippines, and Viet Nam. The workshop is proposed for these 6 countries to share experiences and to explore next steps to achieve sustainable IT-based solutions in health research governance and management. During this workshop we – all participants actively discussed about that how IT can facilitate better and more efficient health research and how to improve research governance and management in each country.Depending on challenges in these fields for Mongolia we all, especially all health science organizations and whole researchers should be thinking seriously about next issues: 1) To improve a collaboration between health research organization and medical practical organization; especially to increase a laboratory technical and technological levels and quality of analyses; in this field should be given more attention from two sides (science and practical sides); 2) To give an attention on improvement of theoretical knowledge and research skills for young doctors and young researchers, regularly; 3) To improve a processes related to improvement of research theme, methodology and involvement of researchers to research projects; 4) To give emphasis on problems related to the clinical trials and ethical issues, previously; 5) To give a more attention on detailed planning of any research work and monitoring, auditing it’s implementations; 6) Most important is documentation or reporting and approvals of any health research work’s results; for this to use of IT solutions, widely; 7) For these goals: a) to improve “MongolMed” online system and increase it’s regular using; b) to build “The Mongolian Health Research Portal”, immediately. Because, today throughout have been needed in emerged development of evidence-based medical practice, but in our country has been continued a health research-medical practice gap.

Since 1990s years Evidence-Based Medicine (EBM) was very important in the world, especially in developed countries, as well as, in UK, USA and others. The emergence of evidence-based practice has to be one of the success stories of the 1990s. In the space of more twenty years the movement has had a significant impact on health care and health policy. Especially, in the UK there are centres, amongst others, for evidence-based medicine, evidence-based child services and mental health services. The depth of influence within UK evidence-based medicine has been paralleled by a breadth of expansion internationally. The movement has rapidly become a global phenomenon transcending national boundaries. An international network to support the development of EBM has developed swiftly in the form of the Cochrane Collaboration, which now has centres in the UK and continental Europe, North and South America, Africa, Asia and Australia.
Over the last few years evidence-based medicine’s approaches have been developed in most health fields, including evidence-based therapy, surgery, gynecology, pediatry, dentistry, nursing, public health, physiotherapy and mental health. Progress has not stopped there: uniquely it would appear that an approach originating in medicine is being advocated and adopted in more distant fields of professional activity, including social work, probation, education anf human resource management.
The development of EBM was thus based on three principles: 1) Doctors must be taught how interpret and use research findings. 2) Doctors must be helped to use research to inform practice throughout their careers. 3) Research findings must be disseminated to doctors in more efficient ways.
Evidence-based practice (EBP) is seen as consisting of five explicit steps:
1. First, the clinician, faced with a patient or group of patients, constructs a specific question concerning their care. This could relate to the diagnosis of the problem, the prognosis or likely outcome of the problem, the most effective treatments and their possible side-effects, or the best method of delivering services to meet patients’ needs.
2. The second stage consists of finding, as efficiently as possible, the best evidence to answer the clinical question.
3. Third, the clinician evaluates the evidence for its validity and usefulness.
4. Fourth, the results are applied to the specific parient or group of patients.
5. Finally, the outcome of the intervention is evaluated.
The aim of EBM is to bring into clinical practice and the fourth stage of the process involves applying the research findings to the care and management of individual patients. The application of clinical research to the care of individual patients presents a core challenge for EBP. The process of evaluation is central to evidence-based medicine. Clinicians using EBM are encouraged to evaluate continually their own performance in relation to their use of EBM and are encouraged to evaluate the validity and importance of clinically relevant research.
But introducing evidence-based medicine’s principles has been needed to very long time in the Mongolian health sector. Especially, we have been needed in a special policy for developing EBM.
Also we have need to knowledge and detailed informations about EBM and it’s principles. Because, in our country should be stimulate this activity.

Learning objectives: After reading this article, readers of the journal should be able to:1. Get information about some aspects of the health sector’s structure and it’s management in the world;2. Understand about current situation of Mongolian health policy (fragmentation of national health policy; but steel has absence of policy on primary health care and medical care);3. Get a short information about health strategic objectives of the official documents: “Millenium Development Goals-Based Comprehensive National Development Strategy of Mongolia” (2007-2021); “Master Plan of Mongolian Health Sector” (2006-2015)4. Understand some ideas for improving management of Mongolian Health Sector on implementation of health strategic objectives, defined by the above mentioned official documents.Summary: Now, in our country, as well as in many countries of the world, has been increased a role of improving health policy and management of the health sector for it’s development. Firstly, we have been needed to Integrated National Health Policy; Secondly, we should be given a more attention to realization of health strategic objectives, already defined by the official documents, which approved in high levels (Mongolian Parliament and Government). The author of this article had trying to some own ideas for improving management of national health sector.

Introduction: First family group practices (FGPs) started to function in 1999 and there are 225 FGPs in Mongolia. FGP is a primary health care unit that renders medical assistance for all urban population in the country. Privatized FGPs act as contractors for state responsibility service and this one of the innovations that raises challenges to make primary health care services more accessible improve their quality and strengthen their human resources. Greater equity of service access and provision depends on structure and capacity of human resources of FGPs. Therefore, there is a need to study human resources provision and their specialization profile in FGPs.Objectives: To study human resource provision and its specialization profile in FGPs of Ulaanbaatar city.Design: Cross-sectional study Material and Methods: Developed registration checklists and questionnaire were used for collection data on human resources, their specialization and training needs.Settings: 77 FGPs in Ulaanbaatar were covered by the studyResults: There were 2273 people per one family doctor and 2233 people per one family nurse. This means that a family doctor and a family nurse provide services for population almost twice greater compared to required standards and it was observed in all districts of Ulaanbaatar. Most of family doctors (71.6%) graduated as basic doctors and only 10.5% of them specialized as family doctors or general practitioners. Some 15.5% of all selected family doctors attended an upgrading training in family practice and only 1.6% attended specialization training. There were 180 nurses covered by the study and 143 (79.4%), 24 (13.3%), 4 (2.2%) and only 2 (1.1%) of them were trained as general nurse, midwife, nursing assistant and family practice nurse, respectively. Some 20(11.1%) of nurses participated in the study attended some specialization training. Some 28% of family doctors stressed that they would like to attend upgrading training courses in family practice, 13% of them training on public health, 12% on healthcare management, 11% on imaging diagnostics, 8% on internal medicine, 6% on traditional medicine and 5% on child health. FGP’s nurses preference of training were as follows: 40%, 22%, 11%, and 18% were on general practice nursing, public health, management and physiotherapy, respectively.Conclusions: The FGP’s physicians and nurses have been provided service to population twice greater than in required standards, and there were only 1.6% and 1.1% of doctors and nurses attended family practice training, respectively. Therefore, there is a need to increase number of professionals in FGPs and provide specialization training to strengthen FGPs human resources.

Introduction: In order to Implement the Mongolian government's 2000 provisions for national health care, on May 28,2004, the Health Minister approved the "Home Care Nursing Service and Rules for Caring and Nursing" according to resolution # 136 and indicated that family clinic nurses should provide home care nursing services [6'71. Interestingly, it is noted that throughout the world, nursing home services have not been limited to family clinic nurses but are being delivered by nurses with diverse areas of specialization.Goal: Purpose of the study is to determine needs for making home nursing services to the population in some province and soum.Objectives:1. To comparatively search needs for providing home nursing services to citizens in the province and soum which were involved to the study.2. To determine nursing type which is required at home3. To develop needs of nurses who make home nursing servicesMaterials and Methods: Conducted studies among the 1109 people from the 520 families in 17 soums of five provinces such as Orkhon, Bulgan, Arkhangai, Khuvsgul and Selenge. We have chosen the clients with anamnesis who are repeatedly served and treated at the hospital for our study and had interviews with them. Questionnaire for citizens consists of 2 basic chapters including 17 questions which determine demographic information and needs of home nursing services. We asked and searched about needs of Home Care Nursing assistances under the 3 basic groups such as General nursing, Treatment nursing and Specialized nursing. After inserting study data into the SPSS-17 program, checked it by appropriate statistical methods (t, x2, fisher exact) and checked if difference between groups and relations has statistical truth.Results: 35.89 percent of clients who got involved to the study answered that they are interested in taking nursing and caring services at home. Also we consider needs for having home nursing at home according to numerical indexes in the provinces involved to the study, clients mostly want to be injected by intramuscular (25.88%), intravenous (31.02%) and IV fluid (30.57%). As we consider specialized nursing assistances at home under the types of needs, health education and assistance for people suffered with hemorrhage and injured people occupy major percent. Clients who got involved to the training, were asked question "With whom do you want to be made nursing assistance at home?" and 75.6% of them answered that they prefer nurses of family clinic.Conclusions:1. It was observed that 35.89% of clients who got involved to the survey, want to receive home nursing assistance and demands for home nursing is being increased with aging.2. Also we conclude that nursing after hemorrhage, nursing for injured patients and nursing for patients with cardiovascular disease occupies higher percent and it shows that percent of cardiovascular diseases and injuries is relatively high and clients' needs to receive nursing assistance at home are faced problems after they were discharged from hospital.3. 75.6% of people who got involved to the study are interested in taking home nursing assistance and we reached to conclusion that it is suitable to train nurses according to it.

Introduction: Today, Health care nursing is dominating only at the hospital but it is deficient at home. Family doctors and nurses actively move around families and receive home calls at the clinic, make assistances but services to prevent from illness, to issue health education and to provide home health care nursing, can’t provide current requirements. Thus, we have chosen this title in order to evaluate health status of citizens who are living in the some district of Ulaanbaatar city and to define demands of home health care nursing.Goal: To search population health who are being served at the some Family Clinic and home health care nursing in Ulaanbaatar city.Оbjectives:1. To make compared research to health status of families which are living in apartments and ger districts.2. To identify faced problems to population health status3. To define needs of people who want home health care nursingMaterials and Methods: We used descriptive model in our research work. We included total 670 people from 156 families which are served of Ulaanbaatar city. We used SPSS 17 software to the processing. Results: 1178 residents of 266 households live in the territory of Songinokhairkhan district, 7th khoroo, and Chingeltei district are studied in our survey. 21% of them stand for 21-30 years old and a minimum amount or 2% of them stand for the people aged more than 71 years old only. 11.7% of all people who included to the research needs to get home health care nursing. Also we considered illnesses of people who have home cares and 1% has gastric ulcer, 6% have paralysis due to hemorrhage in the brain, 1% have cardiovascular disease and 1% has tumor. 28 families or 16.5% offered to move around families to examine aged people, infants and cases, 12.2% offered to give an advice about preventing from illness. 5,7% offered to provide home health care nursing to people who have grave illness and to promptly arrive on home calls.Conclusions:1. 45.5% of families who live in apartments and 70%of families who live in ger districts considered that they have problems in relation to health during the one year and hence 85% of them feel respiratory diseases and it is related to air pollution near to the city.2. The people who live in the ger districts and apartments hypertension and cardiovascular diseases are occupying major percent and it is attracted our attentions.3. 11.7% of families who live in ger districts at our research, need to get home health care nursing. Also we searched knowledge level of nurses for people who have home health care and 87.6% evaluated that they have medium or less knowledge.

Introduction: Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum total bilirubin may be a useful marker for appendiceal perforation. The aim of this study was to determine and compare pre-operative total bilirubin level and other diagnostic tools (patient age, duration of symptoms, Alvarado score, white blood cell, C-reactive protein, ultrasound and contrast enchanced CT scan) in cases of acute appendicitis in order to improve the clinical decision making. Materialsand methods: We identified 102 patient with acute appendicitis after excluding those with other causes of hyperbilirubinemia among the 180 patients that underwent a laparoscopic or an open appendectomy from June, 2011 to March, 2015 in UB Songdo Private Hospital. These cases were also subjected to liver function tests and clinical diagnosis was confirmed perioperatively and postoperatively by histopathological examination. According to histological results, these cases were classified two groups: positive(acute appendicitis with perforation and/or gangrene) and negative(acute appendicitis without perforation or gangrene). Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using independent sample t test, Chi square test, and direct logistic regression. The level of significance was set at P< 0.05. Results: Serum total bilirubin was found to be significantly increased(1,5mg/dL) in case of negative group and much higher (3,6mg/dL) in cases of positive group (P <0.001). The level of total bilirubin was higher than 3 mg/dL in cases of gangrenous/ perforated appendicitis while in cases with acute appendicitis it was lower than 3 mg/ dL. Also Alvarado score (P <0.01), C-reactive protein (P <0.001) and contrast enchanced CT scan (P <0.05) were statistically significant diagnostic tools for acute appendicitis. Conclusion: Assessment of preoperative total bilirubin is useful for the differential diagnosis of gangrenous/perforated appendicitis.

Introduction: Delayed or wrong diagnosisin patients with appendicitis can result inperforation and consequently increasedmorbidity and mortality. Serum total bilirubinmay be a useful marker for appendicealperforation. The aim of this study wasto determine and compare pre-operativetotal bilirubin level and other diagnostictools (patient age, duration of symptoms,Alvarado score, white blood cell, C-reactiveprotein, ultrasound and contrast enchancedCT scan) in cases of acute appendicitis inorder to improve the clinical decision making.Materialsand methods: We identified102 patient with acute appendicitis afterexcluding those with other causes ofhyperbilirubinemia among the 180 patientsthat underwent a laparoscopic or an openappendectomy from June, 2011 to March,2015 in UB Songdo Private Hospital.These cases were also subjected toliver function tests and clinical diagnosiswas confirmed perioperatively and postoperativelyby histopathological examination.According to histological results, these caseswere classified two groups: positive(acuteappendicitis with perforation and/organgrene) and negative(acute appendicitiswithout perforation or gangrene). Theirclinical and investigative data were compiledand analyzed. Statistical analysis wasperformed using independent sample t test,Chi square test, and direct logistic regression.The level of significance was set at P< 0.05.Results: Serum total bilirubin was foundto be significantly increased(1,5mg/dL) incase of negative group and much higher(3,6mg/dL) in cases of positive group (P<0.001). The level of total bilirubin washigher than 3 mg/dL in cases of gangrenous/perforated appendicitis while in cases withacute appendicitis it was lower than 3 mg/dL. Also Alvarado score (P <0.01), C-reactiveprotein (P <0.001) and contrast enchanced CTscan (P <0.05) were statistically significantdiagnostic tools for acute appendicitis.Conclusion: Assessment of preoperativetotal bilirubin is useful for the differentialdiagnosis of gangrenous/perforatedappendicitis.